Allergic rhinitis, better known as hay fever, is the most common form of allergic condition and affects around 26% of Irish people.
Written by Deirdre Butler, Superintendent Pharmacist, Higgins Pharmacy, Market Cross
The allergy and hay fever market in Ireland is growing steadily. The prevalence of allergic rhinitis is rising as found in studies such as ISAAC study of 2006, which found an increase of 13 to 19% during an 8-year period in 13-year-olds.
Dr Ranbin Kaulsay, a Consultant in the Beacon Hospital, also referenced in his article ‘Global warming and Hay fever in Ireland’ that a marked increase in temperature has caused high levels of tree pollens to surge and this can cause a phenomenon known as a ‘pollen bomb’ to occur. Any pharmacist can attest to our Summer this year as being particularly difficult for hay fever sufferers. A large number of over the counter consultations are allergy related.
An increase in pollen levels has been noted to cause significant health concerns especially in patients with asthma. The asthma society specify that 80% of asthma sufferers also suffer with allergies and hay fever. This in turn can exacerbate asthmatic symptoms so caution is required.
NICE guidelines suggest that selfmanagement and environmental strategies are key, such as;
– allergen avoidance
– avoiding drying washing outdoors
– keeping windows shut in cars/ buildings
– planning holidays to avoid pollen season where possible
– showering, wash hair, changing clothes following exposure
– wraparound sunglasses
– using Vaseline around the nostrils
– using saline rinses or sprays to help flush out the allergens
– Ectoin a new innovative product which is in the Fusion Allergy range and HyloDual eye drops. This forms a water like shield over the mucous membranes (eye, nose, skin) and helps block the effects of histamine and prevents allergens and irritants from penetration and causing a reaction.
NICE guidelines for medication treatment reflects the market leaders in the pharmacy market. First line treatment for 2 years and over is non-sedating antihistamines e.g., cetirizine, loratadine and telfast (over 12 years). Cetirizine is the market leader due to general effectiveness and cost.
Intranasal antihistamines are more effective than oral antihistamines but a barrier to access is the fact they are prescription only. If they were allowed to be purchased over the counter this could be a significant opportunity for the pharmacy market.
In moderate to severe hay fever an intra nasal corticosteroid is recommended and Flixonase is the market leader. However there have been many shortages this year where it has been difficult to stock the various over the counter corticosteroid nasal sprays. It is very important to give the correct advice when recommending a corticosteroid nasal spray for example, the correct technique and in some instances, it can take up to two weeks to reach its maximum effect. Failure to do so could result in poor compliance and the medication not working.
In very extreme cases where all techniques and medications have failed, the GP may be able to refer the patient to a specialist.
Dr Ranbin Kaulsay, in his article, speaks about other treatments available such as Intranasal UV phototherapy. This is a new non-interventional and nonpharmacological treatment of rhinitis. This involves using specialised UV lights that are administered into the nostrils for 3 minutes each time for up to 6 to 8 sessions. This is only performed by a trained healthcare professional. This procedure reduces the mucous and allergy cells within the nostrils. Another treatment option is immunotherapy. Success rates have demonstrated 80 to 90% for certain allergens. A considerable body of clinical evidence has established the effectiveness of high dose allergy subcutaneous injections in reducing symptoms and medication requirements.
There are also 2 sublingual immunotherapy treatments for grass pollens available on the GMS and DPS schemes. Oralair (5 grass pollen extract) and Grazax (Timothy grass extract). These treatments are for people with severe grass pollen allergies where standard medications have failed. They can be effective in dampening hay fever for at least 5 years after completion of treatment thus maybe considered to have disease modifying effect.
Pharmacists have an important role in supporting and educating patients. It’s important for each pharmacist or trained colleague to hold a comprehensive consultation with the patient. It’s important to ask them to return to you in 2 to 4 weeks to check their response to treatment.
Identify which symptoms are bothering them, nose, eyes, sinuses, even skin and treat accordingly. Also, open up conversations e.g., if a patient comes in and requests a product by name ask questions such as ‘Is this product sufficient at treating your symptoms? Do you have asthma? If a product hasn’t worked, why? Check compliance, technique, lifestyle factors can all be a cause of treatment failure. These simple steps will help build trust and confidence in you and your team.
References available on request
